|CYO 


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Columbia  ®mbersttp 
in  tiie  Citp  of  JJeto  gorfe 


LIBRARY 


GIVEN   BY 

General  W.  B.  Parsons  T 79 


Digitized  by  the  Internet  Archive 

in  2011  with  funding  from 

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http://www.archive.org/details/inauguraldissertOOraff 


AN 

INAUGURAL  DISSERTATION 


ON 


PULMONARY  CONSUMPTION 


SUBMITTED  TO  THE  PUBLIC  EXAMINATION  OF  THE 

FACULTY  OF  PHYSIC 

UNDER  THE  AUTHORITY  OF  THE  TRUSTEES  OF  COLUMBIA  COLLEGE, 
IN    THE    STATE    OF    NEW-YORK, 

The  Right  Rev.  BENJAMIN  MOORE,  D.  D.  President; 

FOR  THE  DEGREE  OF 

DOCTOR  OF  MEDICINE, 

On  the  5th  Day  of  May,  1807. 


BY  ALIRE  RAFFENEAU  DELILE, 

Of  the  City  of  Versailles,  in  France;  Member  of  the  Institute  of  Egypt, 

of  the  Society  of  Agriculture  of  the  Department  de  Seine  et  Oist; 

Corresponding  Member  of  the  Society  of  Sciences, 

Belles  Lettres  and  Arts  of  Bordeaux ;  and  Member 

of  the  American  iEsculaplan  Society. 


NEW-YORK: 

inted  by  T.  &  J.  SWORDS,  Printers  to  the  Faculty  of  Physic 
of  Columbia  College,  No.  160  Pearl-Street. 

1807. 


tK>I/UMBIANA 

CYo 


nt 


idmff 

■T)f(f 


TO 

DAVID  HOSACK,  M.  D. 

Professor  of  Botany  and  Materia  Medica  in  Columbia  College,  Fellow 

of  the  College  of  Physicians  of  Philadelphia,  of  the  Linnsean 

Society  of  London,  and  Member  of  the  Royal  Medical 

and  Physical  Societies  of  Edinburgh. 

Sib, 

IN  addressing  this  essay  to  you,  I  cannot  but  avail 
myself  of  the  opportunity  of  expressing  to  you  the  obliga- 
tions I  feel,  in  common  with  every  person  attending  the 
medical  school  of  this  city,  for  the  labour  you  have  be- 
stowed in  improving  the  means  of  medical  instruction, 
and  the  liberality  you  have  manifested  in  devoting  the 
earnings  of  your  profession  to  the  establishment  of  a  Bo- 
tanic Garden,  which  being  the  first  that  has  been  instituted 
in  the  United  States,  does  you  infinite  honour,  at  the 
same  time  that  it  reflects  reputation  upon  the  medical 
school  of  New- York,  to  whose  benefit  you  dedicate  it. 
But  I  should  be  ungrateful  not  to  acknowledge  the  kind- 
ness and  attention  I  have  also  individually  received  from 
you.  Accept,  Sir,  the  most  sincere  expression  of  my 
Sentiments  of  gratitude  and  esteem. 

Your  most  obedient  humble  servant, 
A,  R.  DELILE. 


TO 
DOCTORS 

DESGENETTES, 

(Late  Chief  Physician  of  the  Army  of  Egypt)  Professor 
at  the  Medical  School  of  Paris, 


LARREY, 

(Late  Chief  Surgeon  of  the  Army  of  Egypt)  Chief  Surgeon  of  the 
Imperial  Military  Guard; 

Members  of  the  Institute  of  Egypt,  Inspectors  of  the  Service  of  Health 
of  the  French  Armies,  Members  of  the  Legion  of  Honour,  &c. 

THIS  DISSERTATION 

IS  INSCRIBED 

As  a  testimony  of  respect  for  their  talents,  and  of  gratitude 
for  their  kindness, 

BY  THE  AUTHOR, 


ON 

PHTHISIS  PULMONALIS, 

OR 

PULMONARY  CONSUMPTION. 


1  HIS  disease  is  thus  defined  by  Dr.  Cullen: 
"  Corporis  emaciatio  et  debilitas  cum  tussi,  febre 
hectica,  et  expectoratione  plerumque  purulenta." 

Morton  and  Sauvages  have  distinguished  two 
species,  viz. 

Phthisis  sicca,  and  humida.     Sauvages. 

Phthisis  incipiens,  and  confirmata  auctorum, 
Morton. 

The  first  without  expectoration  of  pus;  the 
second  with  a  purulent  expectoration. 

Dr.  Cullen  has  adopted  this  last  distinction, 


HISTORY  OF  THE  DISEASE, 

A  person  predisposed  to  phthisis  is  seized 
commonly  at  the  beginning  of  winter,  or  early 
in  the  spring.  It  commences  with  a  slight  cough, 
and  some  difficulty  of  breathing.     In  some  in- 


(     8     ) 

stances  a  pain  in  the  chest  is  among  the  first 
symptoms;  but  not  being  confined  to  a  particu- 
lar part,  or  felt  only  during  a  full  inspiration,  the 
patient  is  induced  to  consider  these  premonitory 
symptoms  as  nothing  more  than  those  of  a  com- 
mon cold,  and  therefore  neglects  the  use  of  those 
remedies  which  are  calculated  to  arrest  the  pro- 
gress of  the  disease.     The  cough  is  at  first  dry, 
except  when  the  disease  begins  under  the  form 
of  a  catarrh.     It  becomes  gradually  more  fre- 
quent and  troublesome,  especially  at  night.    The 
patient  expectorates  with  difficulty  a  thin  phlegm. 
If  the  remedies  indicated  in  this  stage  of  the 
disease  be  not  timely  applied,  inflammation  in- 
creases.    The  patient  complains  of  more  pain  in 
the  chest,  and  refers  it  generally  to  that  part  of 
the  breast  under  the  sternum,  or  to  one  side,  upon 
which  he  lies  with  some  difficulty.    The  pulse  is 
quick  and  hard,  as  generally  occurs  in  diseases 
in  which  membranous  parts  are  the  seat  of  in- 
flammation.    These  are  unequivocal  symptoms 
of  the  incipient  stage  of  phthisis.     As  the  disease 
advances,  expectoration  increases,  and  the  mat- 
ter discharged  assumes  a  purulent  appearance. 
Hectic  fever   gradually  approaches;   chills   are 
felt  at  intervals,  followed  by  a  dry  state  of  the 
skin,  and  a  sense  of  burning  in  the  palms  of  the 
hands  and  soles  of  the  feet.    Respiration  becomes 
more  frequent,  the  pulse  is  quicker  than  natural, 
the  tongue  and  fauces  are  clean,  red.  and  moist. 


The  regular  .accession  of  fever  is  a  concomitant 
o£  the  suppurative  stage,  and  adds  to  the  debility 
already  existing.  Two  paroxysms  assail  the  pa- 
tient in  the  twenty-four  hours.  The  first  comes 
on  a  little  before  noon,  and  ends  towards  six 
o'clock  in  the  evening.  The  second  succeeding 
at  night,  with  more  severity  than  the  first,  conti- 
nues until  past  midnight;  is  increased  by  the 
warmth  of  the  bed,  and  ends  about  three  or 
four  hr  the  morning  in  a  profuse  sweat,  which 
shows  itself  more  especially  upon  the  head,  neck3 
and  breast  of  the  patient.  A  slight  chill,  a 
quickened  pulse,  a  burning  of  the  hands  and 
feet,  a  circumscribed  redness  of  the  cheeks,  are 
observed  during  each  paroxysm,  but  are  more 
strongly  marked  at  night  than  during  the  pa- 
roxysm  of  the  day.  The  night  sweats  become 
very  profuse,  and  are  usually  attended  with  a 
costive  state  of  the.  bowels.  When  they  dimi- 
nish, diarrhoea  usually  succeeds.  No  nourishment 
can  repair  the  constant  wasting  of  the  body. 
Emaciation  becomes  extreme.  The  balls  of  the 
eyes  sink  into  their  sockets;  the  nails,  wanting  the. 
natural  support  which  the  fat  and  hardened  cel- 
lular texture  afforded  them,  curve  inwards.  The 
whiteness  of  the  teeth  is  remarkable,  owing  pro- 
bably to  a  cause  similar  to  that  which  gives  the 
eyes  a  pearly  hue,  viz.  a  want  of  carbon  in  the 
system,  as  likewise  appears  from  the  general  de- 
ficiency of  fat,  which  requires  for  its  composi- 

2 


(    io    I 

tion  a  great  proportion  of  carbonic  matter.  The 
smaller  circulating  and  absorbent  vessels  lose 
their  tone;  the  legs  become  oedematous.  Small 
pustules  and  ecchymoses  appear  on  the  skin,  the 
expectoration  diminishes,  the  muscular  power 
necessary  to  unload  the  lungs  of  the  great  quan- 
tity of  effused  matter  is  exhausted,  and  the  pa- 
tient, almost  speechless  through  excessive  hoarse-* 
ness  and  debility,  possessed  yet  of  all  his  senses, 
sees  death  approaching,  and  calmly  resigns  him- 
self to  his  fate* 


CAUSES  OF  PHTHISIS  PULMONALE 

The  predisposing  and  exciting  causes  of  phthisis 
are  numerous,  and  as  they  vary,  the  disease 
progresses  moderately,  or  terminates  quickly. 
Among  the  predisposing  causes,  a  scrophulous 
hereditary  taint  is  considered  one  of  the  most 
fatal.  The  relaxed  condition  of  the  glandular 
system  which  takes  place  in  scrophula,  is  also 
extended  to  the  surface  of  the  bronchia,  where 
tubercles  are  probably  formed  at  the  mouths  of 
the  exhaling  vessels. 

A  weak  and  narrow  chest,  which  is  probably 
occasioned  by  the  want  of  vessels  sufficiently 
large  to  carry  a  due  proportion  of  nourishment 
to  that  part  of  the  body,  predisposes  to  phthisis, 
and  is  oftentimes  to  be  met  with  in  persons  of  a 


(  11  ) 

scrophulous  habit,  who  have  passed  their  infancy 
in  a  state  of  languor,  without  that  degree  of  exer- 
cise necessary  for  health,  and  which  alone  is  ca- 
pable of  correcting  this  hereditary  vice  of  the 
constitution. 

The  compression  made  upon  the  lungs  by  con^ 
torsion  of  the  chest  in  diseases  of  the  bones,  de- 
notes a  predisposition  to  phthisis,  marked  also  by 
the  peculiar  affection  of  the  voice  which  is  then 
produced. 

It  has  been  observed,  that  people  of  a  sanguis 
neous  temperament,  in  whom  an  active  circula- 
tion takes  place  in  the  smaller  vessels  upon  the 
surface  of  the  body,  and  which  is  designated  by 
a  peculiar  thinness  and  lustre  of  the  skin,  a  very 
fair  complexion  and  fine  hair,  are  more  subject 
to  consumption  than  people  of  the  bilious  and  me- 
lancholic temperaments.  The  rationale  of  which 
is  found  in  the  delicate  structure  of  the  vessels 
which  are  spread  on  the  surface  of  the  body,  in- 
ternally as  well  as  externally,  and  therefore  upon 
the  lungs  where  they  come  in  contact  with  the  air. 

Sometimes  small-pox,  measles,  and  other  erup- 
tive diseases,  when  suddenly  repelled  from  con- 
striction occasioned  by  cold,  or  the  effect  of 
drastic  purgatives,  have  laid  the  foundation  for 
phthisical  complaints,  most  probably  owing  to 
the  relative  action  which  subsists  between  the 
lungs,  the  alimentary  canal$  and  the  external 
surface  of  the  bodv> 


(      12      ) 

Phthisis  has  been  also  the  consequence  of 
nursing,  in  delicate  mothers,  and  in  those  who 
have  suckled  their  children  beyond  a  period  pro- 
portioned  to  their  bodily  strength. 

In  copious  discharges  of  blood  from  the  uterus, 
or  in  fhior  albus,  when  it  has  been  of  long  dura- 
tion, the  debility  does  not  remain  locally  con- 
fined; the  contents  of  the  chest  are  considerably 
weakened,  and  the  lungs  become  often  the 
seat  of  the  disease.  The  success  of  mercury  in 
some  consumptive  cases,  tends  to  show  that 
phthisis  sometimes  arises  from  syphilitic  virus, 

The  suppression  of  accustomed  or  necessary 
evacuations,  as  of  haemorrhoids  in  males,  and 
the  catamenia  in  females;  the  want  of  them  at 
that  time  of  life  when  they  should  make  their 
appearance,  and  their  cessation  at  the  usual  pe- 
riod, may  occasion  a  disproportionate  determi- 
nation to  the  lungs,  and  produce  phthisisc  The 
suppression  of  the  menses  may  be  a  consequence 
as  well  as  a  cause  of  this  disease,  and  whenever 
it  occurs  is  a  great  source  of  alarm  both  to  the 
patient  and  her  friends,  who  hastily  prescribe  re- 
medies oftentimes  improper  and  dangerous. 

The  want  of  accustomed  stimuli,  as  of  exercise 
in  the  open  air,  of  fermented  or  spirituous  liquors, 
manifest  often  their  bad  effect  by  an  affection  of 
the  chest.  Dr.  D.  Hosack,  in  his  lectures,  ob- 
serves, that  during  his  attendance  as  physician 
at  the  New-York  State  Prison,  many  cases  of 


(     13     ) 

consumption  were  occasioned  by  confinement 
under  such  circumstances,  and  in  persons  other- 
wise not  predisposed  to  complaints  of  the  chest. 
On  the  contrary,  they  possessed  a  good  constitu- 
tion, and  were  supplied  with  as  many  conve- 
niencies  and  necessaries  as  a  well-regulated  insti 
tution  of  this  nature  can  afford. 

Great  and  sudden  changes  of  temperature,  an 
atmosphere  alternately  dry  and  moist,  prove  in- 
jurious to  the  Jungs,  and  predispose  to  phthisis, 
especially  those  who  are  of  a  delicate  habit  of 
body.  In  proof  of  this  it  is  to  be  remarked,  that 
it  is  not  the  disease  of  warm  latitudes,  nor  of 
countries  where  an  uniform  temperature  prevails. 

Hunting,  farming,  a  hardy  life,  and  pursuits 
which  generally  require  exercise  in  the  open  air5 
exempt  from  phthisis.  Frequently  also  they  are 
the  means  of  preventing  that  disease  when  even 
a  predisposition  to  it  exists,  and  one  of  the  most 
effectual  remedies  when  it  has  already  taken 
place.  Accordingly  it  is  remarked  by  Dr.  Rush,* 
that  phthisis  is  unknown  among  the  Indians  of 
this  continent.  It  attacks  people  of  sedentary 
habits,  and  rarely  those  who  are  exposed  to  the 
inclemencies  of  the  weather,  or  whose  occupa- 
tions require  great  muscular  exertion,  as  labourers, 
house-carpenters,  blacksmiths,  and  ship-builders 

This  disease  is  frequent  throughout  the  whole 

*  See  Thoughts  on  Consumption.- 


{      14     ) 

eastern  coast  of  the  United  States,  where  it  isr 
induced  by  the  vicinity  to  the  sea,  the  prevalence 
of  north-east  winds,  and  sudden  changes  in  the 
temperature  of  the  air.  The  moist  climate  of  the 
islands  of  Great-Britain  render  it  common  in 
that  part  of  the  world.  All  large  cities  favour 
its  progress.  Many  trades  predispose  to  it.  Ex- 
traneous matters  received  into  the  lungs  during 
inspiration,  by  millers,  hair-dressers,  and  stone- 
cutters, render  them  very  susceptible  of  phthisi- 
cal complaints.  Dr.  Withering*  has  observed, 
that  whilst  flints  for  potteries  were  pounded  in 
mortars,  the  people  so  employed  universally  died 
consumptive.  Linnaeus,  in  his  valuable  collection 
of  the  Amsenitates  Academicae,f  has  recorded^ 
that  people  who  were  employed  in  Sweden  in 
cutting  grinding-stones  from  quarries,  died  of 
phthisis  before  the  age  of  thirty  years,  from  the 
noxious  effects  of  the  stony  particles  which  they 
inhaled. 

The  dry  grinding  used  in  manufactories  for 
polishing  steel  instruments,  or  pointing  needles, 
has  the  same  pernicious  effect.  We  learn  it  from 
an  interesting  description  given  by  Dr.  Johnstone, 
of  Worcester.  The  iron  dust  which  flies  off, 
with  small  particles  from  the  grinding-stones, 
unite  in  small  balls  with  the  mucus  of  the  bron- 
chia, and  workmen  are  seized  with  cough,   a 

*  See  Letter  to  Dr.  Beeldoes-  f  See  vol.  via.  p.  159 


(      13     ) 

bloody  and  purulent  expectoration,  waste  in  fiesh 
and  strength,  and  die  before  the  age  of  forty  ^ 
Dr.  Kirkland  has  given  a  similar  account  of 
scythe-grinders,  who,  among  themselves,  call 
this  fatal  disease  the  grinder's  rot.  People  em- 
ployed in  spinning  wool,  and  constantly  using 
their  saliva  while  they  breathe  an  atmosphere 
loaded  with  fine  particles  of  wool,  are  also  very 
subject  to  consumption.  Every  person  who  will 
inquire  of  gold-smiths  employed  to  gild  silver., 
by  a  process  during  which  they  necessarily  inhale 
fumes  of  mercury,  will  learn  from  them  to  what 
danger  their  trade  exposes  them.  Blowing  glass 
at  furnaces  is  also  known  to  be  very  pernicious. 
The  violent  exercise  of  the  lungs  and  chest  in 
persons  learning  the  flute,  or  other  wind  instru- 
ments, frequently  does  injury  to  the  delicate  tex- 
ture of  the  lungs.  Writing  at  a  desk,  a  bent 
posture  of  the  trunk,  as  shoe-makers  continue  in 
for  the  greatest  part  of  the  day,  have  a  consider- 
able tendency  to  generate  phthisical  disposition . 


EXCITING  CAUSES. 

Haemoptysis,  or  spitting  of  blood,  readily  pro- 
duces phthisis  in  persons  predisposed  to  this  dis- 
ease. The  vessels  of  the  lungs  in  delicate  habits 
are  easily  ruptured,  and  heal  with  difficulty; 
they  frequently  remain  in  a  state  of  ulceration 


1  16  } 

On  account  of  the  frequency  of  hcemoptoe  as 
the  exciting  cause  of  phthisis,  Dr.  Cullen  has 
placed  this  disease,  with  great  propriety,  in  his 
class  hamorrhagia '.  It  is  also  to  be  observed^ 
that  females  are  more  frequently  the  subject  of 
this  disease  than  males;  which  is  to  be  ascribed 
not  only  to  their  more  delicate  frame  of  body, 
but  also  frequently  to  a  suppression  or  irregula- 
rity of  their  periodical  evacuations.  But  haemop- 
tysis, without  some  predisposition,  is  not  of  itself 
sufficient  to  produce  phthisis.  Persons  of  good 
constitution  recover  with  little  danger  from  the 
rupture  of  a  vessel  in  the  lungs,  occasioned  by 
the  application  of  external  violence  and  other 
causes.  Numerous  instances  have  been  recorded 
by  practical  writers,  of  females  who  have  en- 
joyed perfect  health  after  having  laboured  for 
many  years  under  habitual  discharges  of  blood 
from  the  lungs,  which  nature  seemed  to  have 
substituted  for  menstruation. 

JP yneumoni 'a ,  especially /?/z<?w/?z0?n<z peripneumonia  f 
may  produce  phthisis,  but  requires  the  formation 
of  vomica,  and  a  predisposition  in  the  person 
affected.  This  event  rarely  happens.  With  good 
management  pneumonia  terminates  by  resolution 
towards  the  fifth  or  seventh  day.  Symptoms  of 
inflammation,  however,  may  continue  longer, 
and  the  disease  may  be  protracted  beyond  the 
fourteenth  day;  in  which  case  the  formation  of 
an  abscess  is  to  be  expected.    Its  termination,  by 


.    (      17      ) 

an  opening  into  the  cavity  of  the  pleura,  at  the  ex- 
ternal surface  of  the  lungs,  may  occasion  empyema, 
but  it  may  also  open  into  the  bronchia.  Ulcera- 
tion, in  cases  of  this  sort,  generally  heals  in  a  short 
time,  and  the  frequent  contact  of  air  with  the 
diseased  part  does  not,  as  is  commonly  supposed,, 
prevent  the  cure.  Unfavourable  circumstances 
must  combine  to  produce  phthisis,  to  render  the 
suppuration  acrid,  or  to  occasion  such  change 
in  it  as  may  generate  hectic  fever.  It  does  not 
take  place  without  previous  debility  or  a  defect 
of  constitution. 

Catarrh  in  persons  predisposed  to  phthisis,  may 
be  productive  of  the  disease  by  means  of  the 
unusual  determination  to  the  lungs,  which  exists 
during  the  presence  of  inflammation.  It  acts, 
severely  upon  the  delicate  membrane  of  their 
exhaling  surface,  which,  in  its  structure  as  well 
as  in  its  office,  is  analogous  to  that  of  the  skin, 
which  is  remarkable  in  those  persons  for  its  pe- 
culiar softness  and  transparency.  The  repeated 
efforts  made  by  coughing  to  disengage  and  force 
up  the  mucus  from  the  air  cells,  produces  great 
irritation,  and  at  length  ulceration. 

Asthma  is  usually  enumerated  by  practical 
writers  among  the  exciting  causes  of  phthisis. 
When  this  disease  is  accompanied  with,  or  oc- 
casioned by  deformity  of  the  chest,  we  can  rea- 
dily comprehend  its  operation  in  inducing  phthisis, 
When  asthma  is  attended  with  a  copious  dis* 

3 


i  is  j 

charge  from  the  surface  of  the  lungs,  as  occurs 
In  that  species  called  humoral  asthma,  and  this 
discharge  is  suddenly  suppressed  by  cold  or  other 
causes,  the  inflammation  induced  may  readily 
terminate  in  ulceration  of  the  lungs,  especially 
as  these  organs  are  already  debilitated  by  previous 
disease,  accompanied  with  a  feeble  state  of  the 
constitution.  But  asthma^  like  catarrh,  requires 
predisposition  in  the  habit  to  render  it  an  excit- 
ing cause  of  phthisis. 

Tubercles  are  the  most  common  source  of 
phthisis;  but  as  they  have  been  found  in  some 
instances  without  the  disease,  their  existence 
cannot  be  considered  as  necessarily  producing 
phthisis.  Their  composition  and  nature  have 
never  been  sufficiently  ascertained.  They  differ 
in  different  subjects,  but  always  exist  more  or  less 
in  those  who  die  of  consumption.  They  are  few 
or  numerous;  affect  particular  spots  upon  the 
surface,*  or  are  dispersed  through  the  whole  of 
the  substance  of  the  lungs;  are  solitary,  or  united 
in  small  bunches.  They  frequently  have  the  ap- 
pearance of  small  glandular  bodies;  at  other  times 
they  are  found  in  a  schirrous  state,  enclosing  pus, 
Or  composed  of  a  cheesy-white  or  curdy  sub- 
stance, sometimes  of  a  cretaceous  nature,  which 
crackles  upon  pressure.  In  all  these  cases  they 
certainly  are  diseased  bodies.     I  am  strongly  in- 

*  See  Bailee's  Morbid  Anatomv,  p.  37  and  41,  plates  iv.  and  v. 


f     19     ) 

dined  to  adopt  the  opinion  of  those  authors  who 
have  considered  them  as  schirrous  enlarged  glands 
Morbid  action  and  debility  produce  in  them 
changes  similar  to  those  which  occur  in  the  me- 
senteric glands,  and  in  the  liver  itself  when  en- 
larged by  disease, 

In  the  case  of  a  patient  who,  during  the  course 
of  clinical  lectures  at  the  New- York  Hospital* 
died  this  winter  of  consumption,  after  the  dis- 
ease had  been  accompanied  with  all  the  symp- 
toms, as  I  have  described  them  in  the  history  of 
phthisis,  the  mesenteric  glands  were  found  schir- 
rous, and  considerably  enlarged;  they  contained 
pus,  and  a  white  calcareous  matter,  which  did 
not  differ  from  the  contents  of  tubercles,  which 
were  also  very  numerous  in  the  lungs. 

This  strong  analogy,  as  long  as  glands  are  not 
anatomically  discovered  in  the  lungs,  tends  to 
corroborate  an  opinion  which  has  been  expressed 
by  the  celebrated  physiologists,  Darwin*  and 
Bichat,j*  viz.  "  that  where  tubes  pour  out  from 
secreting  surfaces  a  matter  which  is  not  brought 
from  any  compound  organ  in  view,  they  perform 
no  less  office  than  glands  which  differ  from  them 
by  mere  elongation  of  vessels  and  complication  of 
cells.  This  also  tends  to  show,  that  the  nature  of 
secretions,  their  salutary  or  injurious  qualities^ 


*  See  Zoonomia,  sect.  xxvi.  2, 

4  See  Traite  des  Membranes,  p.  22& 


(     20     ) 

depend  less  on  the  conformation  of  organs  than 
on  the  chemical  combination  of  causes  yet  un- 
known, which  produce  changes  in  the  humours 
and  solids  of  the  body.,  by  destroying  pre-existing 
affinities,  and  creating  new  ones.  Morbid  ana- 
tomy has  thrown  already  much  light  upon  the 
nature  and  functions  of  organs  which  were  im- 
perfectly known.  May  not  tubercles,  or  en- 
larged glands  of  the  lungs,  such  as  they  are  found 
after  deaths  from  consumption,  exist  also  in  other 
diseases  of  debility,  unaccompanied  by  cough, 
expectoration,  hectic  fever,  and  phthisis.  This 
question  cannot  be  resolved  without  numerous 
examples.  I  shall  consider  myself,  however,  suf- 
ficiently authorized  to  conclude  that  tubercles 
may  exist  in  the  lungs  without  much  inconve- 
nience, as  long  as  they  are  not  diseased. 

Scrophula  is  an  exciting  as  well  as  a  predis- 
posing cause  of  phthisis,  when  adventitious,  and 
not  hereditarily  derived  from  a  vice  of  the  con- 
stitution. It  has  its  source  in  the  debility  of  the 
lymphatics,  and  is  seated  more  especially  in  the 
glandular  system.  It  attacks  the  most  vascular 
parts,  and  consequently  the  lungs,  where  it  ge- 
nerates tubercles,  or  acts  with  no  less  danger  by 
impregnating  them  with  its  virus,  which  gives 
rise  to  inflammation,  suppuration,  and  phthisis. 

Contagion  sometimes  spreads  this  disease 
through  members  of  the  same  family.  A  re- 
markable instance  of  this  sort  was  communicated 


{      21      ) 

this  winter  by  Dr.  D.  Hosack,  to  the  gentlemen 
who  attended  his  course  of  medical  lectures. 
This  disease  appeared  in  a  family  of  healthy  well 
made  children,  born  in  this  city  from  parents  of 
good  and  sound  constitution;  one  child  commu- 
nicated it  to  another;  it  extended  in  succession, 
and  proved  fatal  to  them  all.  It  is  known  to  pass 
sometimes  from  a  husband*  to  his  wife,  and  vice 
versa.  But  how  far  this  contagion  may  be  spe- 
cifically extended  is  not  determined.  In  the 
sick  wards  of  hospitals,  where  the  slow  recovery 
and  debility  of  patients  convalescent  from  other 
diseases  predispose  them  to  this  cruel  disorder, 
the  great  number  who  fall  victims  to  it,  in  pro- 
portion to  those  who  die  of  other  diseases  exist- 
ing at  the  same  time,  give  reason  to  suspect,  in 
some  instances,  the  contagious  nature  of  phthisis. 
From  a  comparison  of  this  disease  with  measles 
and  other  contagious  diseases,  it  appears  that 
confirmed  phthisis  possesses  a  specific  virus,  which 
corrupts  the  lungs. 

An  impure  state  of  the  atmosphere,  occasioned 
by  sore  legs  and  other  ulcers,  as  occur  in  hospitals, 
does  not  generate  phthisis  in  persons  breathing 
the  air  thus  vitiated;  but  air  impregnated  with 
the  specific  emanation  of  ulcers  of  the  lungs,  be- 
comes capable  of  producing  the  same  disease  in 


*  See  Darwin's  Zoonomia,  sect,  xxxiii.  2,  7;  and  Letter  to  Dr.  Bed- 
Joes,  p.  64. 


(     22     ) 

persons  who  remain  long  under  the  Influence  of 
some  predisposing  cause.  As  a  proof  that  fetid 
animal  matter,  or  a  vitiated  state  of  the  air  do 
not  alone  favour  the  progress  of  phthisis,  I  shall 
adopt  the  remark  of  Dr.  Withering,  in  his  letter 
to  Dr.  Beddoes,  "  that  people  of  different  trades^ 
who  breathe  an  impure  air  in  confined  places, 
as  butchers  and  cat-gut  makers,  are  less  subject 
to  phthisis  than  other  people. " 


PROXIMATE  CAUSE. 

The  definition  of  a  proximate  Cause,  as  ex« 
pressed  by  Dr.  Gregory,  in  the  following  elegant 
language,  "  Causa  quae  praesens  morbum  facit3 
sublata  tollit,  mutata  mutat,"*  is  perfectly  appli- 
cable in  phthisis,  to  the  ulceration  of  the  sub- 
stance of  the  lungs,  which  appears  to  be  the 
proximate  cause  of  this  disease.  The  vascular 
structure  of  the  lungs,  their  constant  motion  in 
respiration,  render  an  ulcer  of  their  substance 
productive  of  the  great  variety  of  symptoms  at- 
tending phthisis.  The  formation  of  that  ulcer 
is  more  to  be  dreaded,  and  is  more  rapid  and 
more  extensive  in  its  progress,  in  proportion  as 
we  fail  in  our  efforts  to  subdue  the  previous  in- 
flammation of  the  lungs. 

*  See  Conspectus  Medicine 


{  m  ) 

Recoveries  which  we  have  frequent  opportu- 
nities to  see  of  simple  wounds  in  the  lungs,  of 
complicated  gun-shot  wounds,  and  vomica,  are 
evident  proofs  that  such  diseases  are  far  from 
being  incurable:  on  the  contrary,  we  infer  that 
a  suppurating  wound,  or  an  ulcer  of  the  lungs, 
admits  of  cure,  but  that  the  success  depends  on 
the  treatment  pursued  in  the  early  stage  of  it, 
before  sinuses  are  formed,  or  it  has  terminated 
in  tubercles.  Sinuosities  are  well  known  to  re- 
tard the  cure  even  of  external  ulcers.  In  the 
lungs,  which  are  very  vascular,  they  are  also 
readily  formed,  and  from  the  perpetual  movement 
of  these  organs  in  respiration,  they  are  rendered 
more  dangerous  and  difficult  of  cure:  it  is,  there- 
fore, an  useful  precept,  never  to  temporize  in  the 
forming  or  inflammatory  stage  of  this  disease* 


DIAGNOSIS. 

Dr.  Stoll,  of  Vienna,  has  very  properly  called 
turns  sfomachica  a  disease  which  might  be  mis- 
taken for  phthisis.  This  species  of  cough  derives 
its  origin  from  a  foul  state  of  the  stomach,  which 
organ  is  irritated  by  the  presence  of  ill-concocted 
matters,  but  not  to  a  degree  sufficient  to  produce 
nausea  or  vomiting;  it  induces,  however,  an  irre- 
gular action  of  the  diaphragm,  and  extends  its 
irritation  to  the  lungs,  producing  cough  ^  it  also 


(      24      ) 

-occasions  a  foul  tongue,  and  sordes  upon  the 
teeth,  which  symptoms  are  the  reverse  of  what 
take  place  in  phthisis,  and  afford  a  sufficient  dis- 
tinction between  these  two  diseases.  As  tussis 
stomachica  originates  from  improper  diet,  the 
cure  of  it  is  readily  accomplished  by  those  medi- 
cines which  are  calculated  to  cleanse  the  stomach 
and  bowels. 

Common  cold  or  catarrh  may,  in  some  in- 
stances, be  confounded  with  phthisis.  The  in- 
flammation of  the  nasal  cavities,  communicated 
to  the  fauces  and  bronchia,  accompanied  with  a 
sense  of  fulness  in  the  vessels  of  the  head,  is- 
sufficient  to  distinguish  this  disease  from  phthisis > 
nor  is  the  termination  of  catarrh  in  phthisis  to 
be  apprehended,  except  when  some  predisposing 
cause  is  discovered  in  the  general  habit  of  body, 
or  mode  of  living  of  the  patient.  Chronic  ca- 
tarrh, occurring  with  violence,  and  often  proving 
fatal  in  situations  and  at  seasons  in  which  phthisis 
more  generally  prevails,  is  not,  however,  to  be 
confounded  with  it.  Catarrh  renders  the  lungs 
less  capable  of  performing  their  important  func- 
tions, exhausts  the  system  by  the  abundant  se- 
cretion which  it  produces,  is  of  itself  dangerous, 
and  in  some  instances  terminates  in  phthisis. 

Asthma  might  be  mistaken  for  phthisis,  but  is 
generally  periodic  in  its  attacks,  is  characterized 
by  spasmodic  affections,  and  unattended  by  those 
febrile  symptoms  which  constitute  phthisis, 


(     25     ) 

Phthisis  must  also  be  distinguished  from  a  vo- 
mica of  the  lungs.  This  last  affection  of  the  chest 
is  preceded  by  pains  difficult  respiration,  and 
other  symptoms  characterizing  active  inflamma- 
tion. The  great  quantity  of  pus  evacuated  at 
the  moment  the  abscess  opens,  affords  also  a  suf- 
ficient distinction  between  vomica  and  phthisis. 

The  pain  in  the  side,  dry  cough,  hectic  fever, 
produced  by  empyema,  might  be  readily  mistaken 
for  symptoms  of  phthisis,  but  they  proceed  from 
vomica,  pneumonia,  or  external  injury,  which 
serve  to  distinguish  those  diseases. 

Abscesses  of  the  liver  in  some  instances  ex- 
hibit a  train  of  symptoms,  which,  at  first  vieWj 
resemble  those  of  phthisis.  The  matter  of  these 
abscesses  finds  its  way  through  the  lungs  by 
piercing  the  diaphragm.  The  pus,  destruction 
of  parts,  and  ulceration,  are  not  the  effect  of 
phthisis,  and  must  be  carefully  distinguished 
from  it,  as  the  disease  requires  a  particular  treat- 
ment. Dr.  William  Saunders*  has  observed, 
that  sometimes  hepatic  abscesses  open  sponta- 
neously through  the  diaphragm  into  the  air  cells 
of  the  lungs,  giving  passage  to  the  matter  which 
is  thus  evacuated  by  expectoration.  A  similar 
circumstance  is  noticed  as  of  rare  occurrence,  in 
a  memoir  upon  hepatic  abscesses,  by  Bertrandi,f 


*  See  Treatise  on  the  Liver,  p.  220. 

t  See  Memoires  d?  1'Acade.mie  de  Chivurgie  de  Paris,  torn.  Hi.  p.  5Q4. 

4 


(     26     ) 

who,  for  the  description  of  the  fact,  has  referred 
to  the  observations  of  Stalpart  Vanderwiel.* 

This  winter  an  instance  of  the  same  sort  oc- 
curred at  the  New- York  Hospital,  during  the 
attendance  of  Dr.  John  R.  B.  Rodgers,  profes- 
sor of  clinical  medicine. 

A  patient  died  of  hepatitis  after  an  illness  of 
nearly  two  months.  His  body  was  opened,  and 
the  following  is  the  substance  of  the  report  which 
the  professor  read  at  his  lectures ; 

Having  laid  the  abdomen  open,  the  liver  was 
found  enlarged,  and  adhered  considerably  to  the 
diaphragm.  In  separating  the  adhesions,  the 
knife  passed  into  a  sack  in  the  left  lobe  of  the 
liver,  which  was  almost  entirely  hollow  and  full  of 
pus,  mixed  with  blood  perfectly  resembling  mat- 
ter which  the  patient  had  expectorated  before. 
The  diaphragm  was  corroded,  and  the  left  por- 
tion of  the  lungs,  in  other  respects  not  diseased, 
admitted  of  a  passage  for  the  matter  arising  from 
the  corresponding  lobe  of  the  liver.  Another 
cavity,  smaller,  and  perfectly  distinct,  existed  in 
the  great  or  right  lobe,  and  communicated  with 
the  lungs  of  the  same  side. 

The  patient,  from  the  beginning  of  the  disease, 
had  frequently  complained  of  cough.  His  pulse 
was  quickened,  but  neither  hard  nor  full.  His 
tongue  and  teeth  were  covered  with  a  peculiar 

*  See  Obaervatioaes  Raniar.  vol.  ii.  p.  202.    Leyden,  1727V 


(     27     ) 

fur.  The  application  of  blisters  and  anodyne 
mercurial  liniment  to  the  parts  affected;  the 
use  of  proper  remedies  to  mitigate  fever,  to  sup- 
port the  strength,  and  to  ease  the  cough,  gave  the 
patient  little  relief.  He  expectorated  a  consider- 
able quantity  of  matter  tinged  with  ^blood.  Di- 
arrhoea supervened,  convulsions  seized  him,  and 
terminated  in  death. 

TKis  patient,  a  seaman,  had  been  admitted 
into  the  hospital  more  than  a  fortnight  after  the 
first  attack  of  the  disease,  which  he  attributed 
to  a  strain  occasioned  by  hard  work.  He  had 
not  been  in  a  situation  to  receive  timely  medical 
assistance.  The  previous  injury  could  not  be 
overcome  by  the  remedies  which  were  employed, 
and  he  fell  a  victim  to  it.  A  practitioner  unac- 
quainted with  the  possibility  of  this  source  of 
expectoration  in  this  case,  might  have  pro- 
nounced the  disease  phthisis  pulmonalis.  But 
the  appearance  of  the  tongue  and  teeth,  which 
were  foul,  and  the  absence  of  fever  of  a  well- 
characterized  type,  were  sufficient  to  determine: 
the  nature  of  the  complaint 


OF  THE  CURE  OF  PHTHISIS, 

The  means  of  cure  in  this  disease  are  deduced 
from  the  consideration  of  its  causes  and  symp- 


(     28      ) 

toms,  which,  by  early  attention,  may  be  often 
prevented  or  removed. 

In  those  families  where  a  predisposition  to  this 
disease  is  hereditary,  great  care  should  be  be- 
stowed upon  the  first  education  of  the  child* 
and  that  such  regimen  be  observed  as  is  best 
calculated  to  counteract  those  vices  of  the  habit 
to  which  it  is  naturally  inclined. 

With  this  view  it  is  important  that  a  child 
born  of  a  delicate  mother  predisposed  to  phthisis, 
should  be  provided  with  a  nurse  of  a  vigorous 
and  healthy  constitution;  for,  by  continuing  at 
the  mother's  breast,  frequently  both  the  parent 
and  child  are  sacrificed. 

For  the  same  purpose,  removing  children  from 
the  city  into  the  country,  which,  for  a  part  of  the 
year  at  least,  is  commonly  practicable,  seldom 
fails  to  improve  their  constitution,- and  generally 
succeeds  in  giving  vigour  to  such  as  are  of  a  weak 
or  delicate  habit  of  body. 

We  are  confirmed  in  the  propriety  of  this  re- 
mark by  observing  the  greater  degree  of  health,, 
and  the  more  robust  form  of  body,  which  chil- 
dren educated  in  the  country  acquires  compared 
with  those  born  and  brought  up  in  cities.  The 
hardy  mode  of  life,  the  active  amusements  of  the 
country,  the  freedom  from  the  restraints  of  dress 
and  fashion  common  in  cities,  all  concur  to  im 
prove  the  constitution . 


(     29     ) 

In  this  place  the  remark  also  naturally  occurs* 
that  the  present  fashion  of  dress  adopted  by 
young  ladies,  is  not  a  little  calculated  to  increase 
this  disease.  Tight  lacing  the  chest,  and  the  use 
of  corsets,  by  impeding  respiration  and  confin- 
ing the  motion  of  the  ribs,  of  themselves  be- 
come, in  some  instances,  exciting  causes  of 
phthisis;  but  where  a  predisposition  to  consump- 
tion exists,  they  invariably  serve  to  increase  it. 

In  the  different  occupations  or  trades  injurious 
to  health,  frequently  much  is  to  be  done  by  early 
attention  to  the  means  of  counteracting  their 
jnischievous  tendency;  but  in  some  instances  the 
most  cautious  management  cannot  guard  against 
the  ill  effects  of  particular  employments:  the 
only  remedy  in  such  cases,  is  for  the  patient  not 
to  persist  in  an  occupation  found  to  be  un- 
healthy, but  to  resort  early  to  another  branch 
of  business,  before  his  health  is  irrecoverably  im- 
paired. 

The  diseases  which  are  most  commonly  the 
exciting  causes  of  phthisis,  viz.  haemoptysis, 
pneumonia,  catarrh,  &c.  call  for  the  aid  of  an 
attentive  physician  to  accomplish  the  cure,  and 
should  teach  the  patient,  when  recovered,  not 
to  expose  himself  to  the  danger  of  a  relapse. 
Proper  dress  and  diet  have  generally  the  most 
happy  effect  in  preventing  a  return  of  the  evil. 
When  carefully  attended  to  for  a  certain  space 
of  time,  they  not  only  restore  the  usual  strength 


(     30     ) 

to  the  system,  but  sometimes  invigorate  it  to  a 
degree  which  may  allow  afterward  of  small  irre- 
gularities; for  an  injurious  cause  produces  a  slight 
transitory  effect  upon  a  person  in  health,  while 
it  generates  a  disease  in  others  debilitated  by  long 
irregular  habits. 

A  strict  attention  to  dress  and  diet  is  almost 
impossible  in  many  circumstances;  in  others  the 
constant  watchfulness  which  it  might  create,  the 
frequent  privations  to  which  it  might  expose, 
would  be  productive  of  as  great  inconvenience 
and  injury  as  the  approach  of  the  disease  itself. 
Nevertheless,  the  good  effect  of  regimen  will  not 
be  denied  in  all  cases  where  it  is  practicable. 

It  is  not  less  important  in  the  treatment  of 
phthisis  to  attend  to  the  cause,  than  to  the  stage 
and  symptoms  of  the  disease;  as  remedies,  to  be 
exhibited  with  success,  must  accordingly  be  ac- 
commodated to  the  case. 

Thus,  in  young  women,  when  irritation  at  the 
chest  indicative  of  approaching  phthisis  takes 
place,  at  the  same  time  that  the  catamenia  should 
make  their  appearance,  it  not  unfrequently  ori- 
ginates from  a  morbid  sensibility  of  the  nervous 
svstem  which  sometimes  attends  that  period  of 
life.  This  sensibility  first  discovers  itself  in  pro- 
ducing irritation  at  the  stomach,  hysteria,  flatu- 
lence, loss  of  appetite,  a  dislike  for  animal  food, 
a  fondness  for  acids,  pickles,  and  such  articles 
as  make  a  strong  impression  upon  the  stomach. 


(     31      ) 

From  the  same  source  of  irritation  proceed  pain 
in  the  chest,  a  frequency  and  shortness  of  breath- 
ing, a  troublesome  hacking  cough,  a  general  loss 
of  strength,  fever,  and  night  sweats.  These  com- 
plaints, if  neglected  or  mismanaged,  readily  ter- 
minate in  a  confirmed  consumption  of  the  lungs; 
whereas,  tonic  remedies,  such  as  steel,  bitters, 
a  generous  and  nutritious  diet,  exercise  in  the 
open  air,  short  journies,  especially  on  horseback, 
should  be  prescribed,  and  will  effect  a  cure,  by 
diminishing  the  morbid  sensibility,  and  thereby 
removing  the  first  cause  of  the  disease. 

In  like  manner,  when  incipient  phthisis  proceeds 
from  an  exhausted  srate  of  the  system  induced  by- 
suckling,  if  the  cause  be  not  attended  to  by  the 
physician,  he  will  prescribe  in  vain,  and  not  un- 
frequently  both  mother  and  child  perish  from  his 
inattention  to  the  great  source  of  the  evil. 

Again,  when  phthisis  is  the  consequence  of 
the  cessation  of  the  menses,  a  moderare  bleed- 
ing (even  when  the  habit  under  other  circum-. 
stances  might  forbid  the  use  of  the  lancet  and 
other  debilitating  remedies)  will  generally  re- 
move the  plethora  which  is  induced ;  whereas, 
blisters,  emetics,  issues,  and  pectoral  remedies 
usually  prescribed,  so  far  from  removing  the  dis- 
ease, will  serve  oftentimes  to  hasten  its  progress. 

It  will  be  proper  in  this  place  to  make  some 
observations  upon  the  use  of  the  lancet  in  this 
disease.     The  experience  of  practitioners  most 


{     32     } 

conversant  with  the  treatment  of  consumption^ 
teaches  us  that  blood-letting  should  be  in  a  great 
degree  confined  to  the  first  stage  of  this  disease; 
that  in  the  latter  stage,  its  debilitating  effects 
counteract  the  advantages  otherwise  to  be  ex- 
pected from  this  remedy.  Moderate  bleeding  in 
incipient  phthisis  relieves  the  pain  in  the  chest, 
renders  respiration  less  frequent,  and  by  restor- 
ing the  secretions  which  had  been  interrupted, 
facilitates  the  transmission  of  blood  through  the 
lungs,  and  thereby  unloads  those  organs  of  the 
disproportionate  quantity  of  fluids  which  had 
oppressed  them;  but  this  remedy  is  to  be  em- 
ployed with  a  cautious  hand,  for  if  frequently  re- 
peated, or  the  evacuation  be  too  large,  the  debi- 
lity which  ensues  will  soon  be  succeeded  by  an 
irremediable  train  of  symptoms. 

The  buffy  or  sizy  appearance  of  the  blood 
drawn  in  this  disease,  I  am  induced  to  con- 
sider as  an  equivocal  test  of  inflammation,  inas- 
much as  it  is  frequently  observed  in  diseases 
unattended  with  other  symptoms  of  inflamma- 
tion, and,  therefore,  must  prove  a  fallacious  evi- 
dence of  the  necessity  of  blood-letting  in  phthisis, 
especially  too  as  the  buffy  coat  is  not  uncommon 
in  this  disease,  even  at  that  period  when  the  pa- 
tient is  sinking  under  excessive  debility.  The 
prudent  and  judicious  physician,  in  forming  his 
opinion  of  the  propriety  of  blood-letting,  will 
be  guided  by  the  general  condition  of  the  pa- 


(     35      ) 

iient,  the  state  of  the  pulse,  the  tongue,  the 
digestive  organs,  and  period  of  the  disease,  as 
well  as  the  appearance  of  the  blood  drawn. 

Emetics  aid  expectoration,  promote  cutaneous 
perspiration,  produce  a  revulsion  of  morbid  ac- 
tion and  irritation  from  the  lungs,  and  allay  the 
frequency  and  difficulty  of  breathing.  Their  good 
effects  have  led  practitioners  to  employ  a  great 
variety  of  emetic  substances  in  order  to  select  the 
quickest  and  least  debilitating.  Antimonial  pre- 
parations and  ipecacuanha  have  sometimes  been 
objected  to,  as  acting  upon  the  bowels.  They  are, 
however,  safe  remedies  in  the  first  stage  of  phthisis. 

The-  sulphate  of  copper,  or  blue  vitriol,  acts 
almost  instantaneously  when  taken  into  the  sto- 
mach; its  action  is  chiefly  confined  to  that  organ, 
and  is  less  debilitating  to  the  system  than  those 
emetics  most  in  use. 

Dr.  Simmons  has  employed  it  with  good  effects 
prescribed  as  follows:  The  patient  swallows 
first  about  half  a  pint  of  water,  and  a  solution 
of  a  few  grains  of  blue  vitriol  immediately  after. 
The  whole  is  instantly  rejected;  and  the  same 
effect  is  next  to  be  obtained  from  drinking  a 
second  glass  of  water,  which  commonly  termi- 
nates its  operation. 

Dr.  Thomas  Maryat  recommends*  the  blue 
vitriol,  with  tartrite  of  antimony,  in  the  proportion 

v"  See  New  Practice  of  Physic,  p.  88. 

.o 


{     5*    ) 

&{  two  grains  and  a  half  of  each*  in  a  spoonful 
of  water.  From  the  small  quantity  of  water  in 
which  this  emetic  is  exhibited,  it  is  called  the 
dry  vomit. 

The  sulphate  of  zinc  in  solution,  according  to 
-the  prescription  of  Dr.  Moseley,f  affords  a  con- 
venient and  safe  emetic.  One  or  two  spoonsful 
produce  vomiting  without  debilitating  effects. 

Dr.  Reid  has  recommended  ipecacuanha  both 
with  and  without  the  sulphate  of  zinc,  and  has 
placed  much  confidence  in  the  daily  exhibition 
of  that  emetic  as  successful  in  the  treatment  of 
phthisis,  not  only  in  the  first  stage,  but  also  in 
some  instances  even  in  the  second.  He  considers 
that  the  compression  made  upon  the  lungs  by  the 
action  of  the  diaphragm  in  vomiting,  evacuates 
the  viscid  and  purulent  matter  accumulated  in 
the  bronchia,  and  removes  the  obstructions  of 
the  biliary  vessels  and  chylopoetic  organs.  In 
this  manner  the  patient  is  freed  from  a  great 
source  of  pain  and  irritation,  at  the  same  time 
that  he  is  thereby  enabled  to  make  use  of  tonic 
medicines  and  nutritious  diet. 

*  See  New  Practice  of  Physic,  p.  23. 
f  §!  Vitriol   alb     3  hj« 
Alum.  rup.  3j» 
Coccinellse  pulver.  gr.  iij. 

Aquae  ferventis  Ibj.  Misce  in  mortario  marmoreo* 
Solutio  a  fjeculentia  vel  residendo  expurgetur,  vel  per  char- 
tarn  bibulam  filtretur.  Treatise  on  Tropical  Diseases-,  p. 
384  and  542, 


(     35     ) 

A  little  reflection  on  the  nature  of  this  disease 
serves  to  fix  the  extent  to  which  emetics  may 
be  useful.  When  abused,  they  weaken  the  di- 
gestive organs;  and  in  phthisis  all  hope  of  re- 
cruiting the  strength,  which  gradually  vanishess 
rests  upon  the  powers  of  the  stomach  and  intes- 
tines to  receive  and  to  transmit  nourishment. 

Epispastics,  viz.  blisters,  setons  and  issues,  are 
indicated  in  phthisis  to  remove  the  irritation  from 
the  lungs,  They  stimulate  without  danger  the 
external  parts  which  are  not  possessed  of  the  ex- 
quisite sensibility  of  the  organs  affected.  Their 
great  efficacy  is  not  owing  to  the  local  discharge 
which  they  produce,  but  rather  to  the  artificial 
irritation  which  they  occasion,  and  which,  ac- 
cording to  the  experience  of  practitioners,  ren- 
ders blisters  preferable  to  issues  and  setons.  Dra 
Mudge  was  cured  of  consumption  by  the  appli- 
cation of  an  issue,  and  has  observed,  that  the 
salutary  effect  of  the  remedy  depends  on  the 
great  quantity  of  the  discharge  produced,*  This 
opinion  is  not  well  founded,  for  if  the  patient's 
recovery  depends  upon  the  depletion  of  the  sys- 
tem, we  might  obtain  this  end  more  effectually 
by  means  of  blood-letting,  cathartics,  &c.  and  I 
am  disposed  to  believe  that  a  local  irritation  stimu- 
lates at  the  same  time  the  whole  nervous  system, 
occasions  a  favourable  transfer  of  excitement,  and 

*  See  Dr.  J.  Mudge  on  Cai;.;-rhc^  Ouo-h,  p,  5$ 


(      36     7 

thus  diminishes  the  violence  of  the  disease*  The 
repeated  application  of  blisters,  upon  this  prin- 
ciple, is  to  be  preferred,  both  in  the  incipient  and 
confirmed  stages  of  phthisis,  to  issues,  setons,  or 
blisters  kept  open  by  epispastic  dressings. 

Laxative  medicines  promote  the  circulation  in 
the  abdomen,  stimulate  gently  the  alimentary 
canal,  prevent  the  torpor  which  costiveness  might 
Induce  upon  the  secreting  organs,  and  thereby 
contribute  to  the  cure  of  phthisis  in  its  first  stage. 

Nitrous  medicines,  aperients  and  sudorifics  di- 
minish the  heat  of  the  body  and  febrile  excite- 
ment; linseed  tea,  barley  water,  and  mucilagi= 
nous  drinks,  are  also  very  proper  auxiliaries. 

Anodynes,  given  at  night  to  procure  rest  and  to 
allay  cough,  are  attended  with  good  effects,  and 
In  many  instances  are  indispensably  necessary, 
especially  when  an  emetic  has  been  previously 
employed  to  unload  the  lungs. 

Mercury,  by  producing  a  general  action  of  all 
secretory  organs,  is  a  valuable  remedy  in  phthisis 
When  it  produces  salivation  the  disease  is  sus- 
pended, and  for  the  time  totally  removed;  but 
it  frequently  recurs  when  the  salivation  ceases. 
We  therefore  observe,  that  even  those  remedies 
which  have  been  considered  as  the  most  valuable, 
have  no  specific  effect  in  the  removal  of  phthisis. 
The  moderate  use  of  mercury  in  the  first  stage 
of  this  disease,  may  undoubtedly  be  of  service,, 
Dr.  Reid  considers  that  it  acts  successfully  as  a 


.      (     37     } 

4eobstruent,  and  that  it  is  of  doubtful  efficacy  in 
the  second  stage;  and  gives  different  cautions 
against  its  use  in  some  cases.*  The  practice  of 
the  physicians  attending  at  the  New- York  Hos- 
pital, has  convinced  me  that  its  exhibition  in 
many  instances,  even  so  far  as  to  produce  slight 
salivation  (at  the  same  time  that  other  remedies 
are  applied  to  allay  cough  and  irritation),  may 
promote  the  resolution  of  tubercles,  and  thus 
contribute  to  the  cure  of  the  disease, 

The  digitalis  purpurea,  or  fox-glove,  a  plant  of 
the  natural  order  of  solanacece^  which  all  partake 
of  a  narcotic  quality,  has  been  celebrated  for 
the  cure  of  phthisis;  but  physicians  have  differed 
widely  in  their  opinion  with  respect  to  this  re- 
medy. No  less  contradiction  exists  concerning 
its  advantages  than  its  mode  of  operation. 

It  appears  that  the  use  of  this  medicine  was 
first  introduced  with  an  expectation,  that  as  it 
had  been  found  successful  in  scrophula,  it  might 
also  be  successfully  employed  in  phthisis,  the 
obstinate  and  incurable  nature  of  which,  in  many 
cases,  is  ascribed  to  a  scrophulous  taint.  This 
reflection  arises  from  a  passage  in  the  writings^ 
of  Dr.  Beddoes,  whose  surprise  is  somewhat  em* 
phatically  expressed,  that  digitalis  had  not  been 
sooner  thought  of  as  a  remedy  in  consumption 


*  See  Essay  on  Phthisis,  p.  188. 

t  See  Murray's  Apparatus  Medicaminum,  torn.  i.  p.  72B, 

|  See  Essay  on  Consumption,  p.  265, 


(     58     } 

of  the  lungs,  especially  as  its  sensible  effects  had 
been  long  known,  and  readily  suggested  the  ap«? 
plication  of  it  to  a  variety  of  diseases. 

The  celebrated  Haller,  more  than  half  a  cen- 
tury ago,  in  his  work  upon  Helvetic  plants,  has 
expressed,  in  the  following  terms, the  opinion  then 
entertained  of  digitalis:*  "  Pro  vulneraria  babe- 
tur  Lobel.  et  ad  strumas  commendatur  impo- 
nenda.  Sed  acris  est  et  vomitus  alvumque  ciet 
Rai.  ut  inter  venenatas  censeatur  Boerhaavio. 
Extus  contusam  herbam  et  unguentum  ex  floribus 
ad  podagram,  ad  strumas  et  rachitidem  Anglif. 
laudant;  nostris  officinis  ignota  est." 

With  the  supposition  that  digitalis  might  dis« 
cuss  tubercles  of  the  lungs  as  well  as  scrophulous 
tumours,  its  use  had  become  for  a  while  almost 
universal  and  indiscriminate.  With  a  similar 
theoretical  view  Dr.  Michael  Ryan  J  has  recom- 
mended cicuta  and  the  juice  of  the  leaves  of 
hissilago  or  colt's -foot. 

Experience  has  fully  discovered  the  properties 
of  digitalis.  It  must  be  given  in  small  quantities, 
not  exceeding  a  few  grains  of  the  powdered 
leaves,  or  a  few  drops  of  their  tincture,  which  is 
preferable.     A  dose  of  ten  or  twenty  drops,  re- 


*  See  Stirp.  Helvet.  p.  617. 

f  Digitalis  is  indicated  as  a  remedy  for  consumption,  in  a  work  of 
the  year  1710,  by  W.  Salmon.  See  London  Medical  Review  and 
Magazine,  vol.  v.  p.  303. 

$  See  Inquiry  into  the  Nature..  Causes,  and  Cure  of  Consumption, 
p.  158. 


(     39     ) 

peated  four  or  five  times  a  day*  may  be  gradu- 
ally increased. 

This  medicine  has  a  very  sensible  effect  in  di- 
minishing the  frequency  of  the  pulse,  and  some- 
times reduces  it  considerably  below  its  natural 
standard.  It  renders  respiration  slower  than  na- 
tural, and  if  the  dose  be  considerable,  it  produces 
nausea,  vomiting,  fainting,  vertigo,  stupor;  and 
if  taken  in  very  large  quantity,  or  by  accident, 
it  operates  as  a  poison,  and,  like  opium,  proves 
fatal.  In  one  respect  it  differs  from  the  other 
narcotics;  it  acts  powerfully  in  increasing  the  se- 
cretion of  urine:  hence  it  holds  a  place  in  the 
materia  medica  as  a  diuretic,  and  has  been  a 
fashionable  remedy  in  the  treatment  of  dropsy ^ 
but  as  its  sedative  operation  is  very  considerable,, 
we  need  not  be  surprised  that  it  should  have 
fallen  into  disrepute  in  that  disease,  which  in 
most  instances  is  the  effect  of  debility. 

In  phthisis  a  specific  power  to  remove  tuber- 
cles has  been  ascribed  to  this  plant,  and  this 
operation  has  been  accounted  for  by  supposing 
that  it  increased  the  action  of  the  absorbent  ves- 
sels, and  enabled  them  to  carry  away  the  matter 
composing  tubercles.  A  supposition  of  this  sort 
is  not  only  groundless,  but  contrary  to  sound 
reasoning;  since  this  medicine,  by  reducing  the 
force  of  the  heart  and  arteries,  and  consequently 
diminishing  motion,  cannot  at  the  same  time  in- 
crease the  action  of  a  particular  set  of  vessels, 


(     40     } 

I  hare  seen  this  medicine  judiciously  prescribed 
in  a  number  of  cases  at  the  New- York  Hospital 
and  the  Alms-House,  without  that  success  which 
might  have  been  expected  from  the  advantageous 
reports  given  by  some  of  the  most  celebrated 
practitioners  of  England.  In  several  instances 
It  diminished  sensibly  the  frequency  of  the  pulse, 
but  did  not  produce  any  essential  change  in 
the  disease;  the  expectoration  continued  no  less 
abundant,  and  the  gradual  decay  of  the  patient's 
strength  increased,  notwithstanding  the  exhibi- 
tion of  bitters,  tonic  remedies,  and  nourishing  diet. 
The  great  difference  of  results  in  this  country, 
from  those  published  by  Dr.  Magennis*  in  En- 
gland, renders  it  necessary  for  me  to  adduce  the 
testimony  upon  which  I  have  formed  an  opinion 
of  the  virtues  of  this  medicine.  In  doing  this  I 
shall  avail  myself  of  the  observations  of  Dr.  Ho- 
sack,  communicated  in  his  lectures  on  the  Ma- 
teria Medica,  and  which  he  has  permitted  me  to 
use. 

"  On  account  of  the  sedative  operation  of  this 
plant,  it  has  lately  been  restored  to  the  Materia 
Medica  as  useful  in  phthisis  pulmonaiis.  During 
my  attendance  as  physician  at  the  State  Prison, 
the  New-York  Hospital,  and  the  Aims-House,  as 
well  as  in  my  private  practice,  I  have  had  op- 
portunities of  prescribing  it  frequently  in  all  the 

se  London  Medical  and  Physical  Journal  vol.  v.  p 


(     41      ) 

different  stages  of  that  disease;  in  some  with  de- 
cidedly good  effects;  in  others  it  manifestly  did 
harm.  In  the  first,  or  inflammatory  stage  of  that 
disease,  it  was  useful  in  removing  the  pain  and 
soreness  of  the  chest,  in  lessening  the  frequency 
of  the  cough,  in  facilitating  expectoration,  and 
in  diminishing  febrile  action  in  general;  but  in 
the  advanced  or  latter  stage  of  the  disease,  it 
sunk  the  strength  of  the  patient,  destroyed  the 
appetite,  and  in  all  respects  increased  the  violence 
of  the  complaint. 

"  In  one  case  of  incipient  phthisis,  preceded 
by  haemorrhage  from  the  lungs,  it  operated  like 
a  charm  in  relievirig  the  patient  from  some  of 
the  most  formidable  symptoms  of  the  inflamma- 
tory stage  of  that  disease.  The  same  medicine 
will  also  probably  be  found  a  valuable  acquisition 
in  the  treatment  of  most  inflammatory  complaints, 
and  may  be  no  less  useful  in  pleurisy,  peripneu- 
mony,  or  inflammation  of  the  brain5  than  in  the 
first  stage  of  phthisis. 

u  I  fear,  however,  that  from  the  promiscuous 
prescription  of  it  in  every  stage  of  that  disease, 
it  may  lose  the  reputation  which  it  has  lately  ac- 
quired. 

"  It  was  observed  by  Dr.  Young,  in  his  trea- 
tise on  opium,  that  that  medicine  is  improper 
where  blood-letting  is  necessary;  I  remark  of 
digitalis,  that  it  is  only  useful  where  blood-letting 
and  other  depleting  remedies  are  indicated," 


{      42      ) 

The  good  effect  of  the  remedies  which  I  have 
already  mentioned,  depends  altogether  upon  the 
propriety  and  time  of  their  application,  as  no 
other  advantage  can  be  derived  from  their  num- 
ber than  the  convenience  of  choice,  according  to 
symptoms  and  circumstances. 

Warm  bathing  is  a  valuable  remedy  in  addition 
to  those  generally  used.  The  bath,  at  a  tempe- 
rature not  exceeding  92°  of  Farenheit's  ther- 
mometer, abates  febrile  heat,  opens  the  pores  of 
the  skin,  equalizes  the  circulation,  and  promotes 
the  secretions  generally;  on  these  accounts  it  is 
an  useful  remedy  in  the  inflammatory  stage  of 
phthisis. 

Inhaling  the  steam  of  warm  water  is  also  very 
proper;  it  relaxes  the  inflamed  membrane  of  the 
bronchia,  and  assists  the  secretion  and  expecto- 
ration of  matter. 

Factitious  airs,  viz.  carbonated  hydrogen,  car- 
bonic acid*  gas,  or  hydrogen,  combined  with  a 
sufficient  portion  of  atmospheric  air  to  render 
them  respirable  with  as  little  danger  as  possible, 
have  been  tried  often  with  apparent  success. 
Owing  to  a  specific  quality,  and  to  the  absence 
of  a  due  proportion  of  oxygen,  they  diminish 
the  strength  and  frequency  of  the  pulse,  render 
the  respiration  less  frequent,  and  produce  a  dis- 
position to  sleep.  They  seem  calculated  rather 
for  the  first  than  for  the  second  stage  of  phthisis. 

On  the  contrary,  oxygen  gas  increases  arterial 


(     43      ) 

action,  gives  a  momentary  vigour  to  the  system, 
and  might  perhaps  be  useful  in  the  second  stage 
of  the  disease.  Its  good  effects  are  unquestion- 
able in  several  diseases  arising  from  nervous  af- 
fections ;  but  in  phthisis,  the  great  exhaustion 
which  threatens  the  system  renders  the  success 
of  oxygen  doubtful.* 

Modern  researches  in  natural  philosophy  have 
given  rise  to  the  pneumatic  branch  of  medicine, 
which  owes  its  fame  to  the  writings  and  experi- 
ments of  Priestley,  Black,  Lavoisier,  Fourcroy, 
Beddoes,  Percival,  Thornton,  and  other  practi- 
cal observers.  The  methods  to  procure  the  dif- 
ferent gases  have  been  rendered,  simple,  and  con- 
venient; extensive  observations  have  been  re- 
peated to  discover  the  circumstances  to  which 
those  gases  are  applicable;  and  this  science  is 
dailv  improving.  Having  only  witnessed  the 
effect  of  gases  in  a  few  experiments,  I  shall  refer 
to  the  writings  of  practical  authors  for  informal 
tion  upon  this  subject. 

The  diet  in  the  first  stage  of  phthisis  should 
be  composed  of  fruits  and  vegetables  chiefly. 
Diluent  and  mucilaginous  drinks  are  likewise 
extremely  proper,  and  when  inflammatory  symp- 
toms subside,  milk  is  a  proper  nourishment.  A 
certain  proportion  of  lime-water  succeeds  some- 
times to  accommodate  milk  to  weak  stomachs. 

*  See  Chaptal's  Elements  of  Chemistry,  vol.  i.  p.  139. 


(     44     ) 

where  a  disposition  to  acescency  exists;  but  it 
should  never  be  given  in  union  with  brandy  or 
pther  spirituous  liquors.* 

Great  benefit  is  derived  from  the  well-regulated 
temperature  of  the  apartment  of  the  patient. 
A  partial  stream  of  cool  air  from  a  window  or 
door  is  very  injurious  to  consumptive  persons;  i\. 
increases  the  disposition  to  cough,  and  must  be 
carefully  avoided. 

Moderate  exercise  in  the  open  air,  walking, 
riding,  &c.  in  a  mild  day,  are  of  service.  Flan- 
nel worn  next  the  skin  affords  the  best  defence 
against  the  variations  of  the  atmosphere.  Its  use 
should  be  recommended  to  ail  persons  affected 
with  symptoms  of  phthisis,  who  become  particu- 
larly sensible  of  the  changes  of  the  air. 

With  respect  to  the  salutary  effect  of  wearing 
flannel,  which  might  be  more  generally  intro- 
duced in  public  establishments,  a  report  of  the 
New-York  State  Prison,  published  in  the  year 
1800,  by  one  of  the  inspectors,  deserves  to  be 
mentioned.  In  that  publication  the  author  states, 
that  since  flannel  had  been  used  as  recommended 
by  the  Physician  (Dr.  Hosack),  "  the  number  of 
the  sick  had  decreased,  the  diseases  became  less 
Violent,  and  fewer  deaths  occurred. "f 


*  See  Fothevgili.  London  Medical  Observations  and  Inquires 
vol.  v.  p.  376. 

f  See  an  Account  of  the  State  Prison  or  Penitentiary-House,  p.  90. 
New-York.    Isaac  Collins  and  Son.    180J. 


(     45     ) 

The  confirmed  stage  of  phthisis  requires  tonic 
remedies,  and  a  diet  which  the  first  or  inflam- 
matory stage  forbids.  Blisters,  even  at  an  ad- 
vanced period,  may  be  repeated  with  success, 
but  as  they  probably  do  good  by  the  irritation 
which  they  excite,  and  not  by  the  discharge  they 
produce,  it  is  desirable  to  have  all  the  advantage 
of  their  first  effect  without  the  debility  produced 
by  the  latter.  The  best  method  is  to  dress  the 
blister  with  some  mild  ointment,  and,  when 
healed,  to  renew  it  if  the  pain  in  the  chest  ren- 
ders it  necessary. 

Aromatic  and  stimulating  bitters  give  tone  to 
the  muscular  fibre,  prevent  the  return  of  febrile 
paroxysms,  lessen  the  expectoration,  and,  by  di- 
minishing fever,  render  the  night  sweats  less  fre- 
quent and  profuse. 

The  *nost  efficacious  medicines  for  that  purpose 
are  the  poly  gala  senega,  aristolochia  serpent  aria, 
columbo,  and  gentian  roots. 

Infusions  of  boneset  (eupatorium  perfoliatum), 
horehound  (marrubium  vulgare),  or  lichen-islandi- 
fiis,  upon  the  same  principle,  are  useful  tonics, 
and  may  be  given  freely  during  the  remission  of 
fever. 

Myrrh  and  ammoniac  are  also  useful  stimulants 
in  this  disease:  they  diminish  the  expectoration, 
and  contribute  to  support  the  strength  of  the 
patient.  These  gummi-resinous  substances  may 
be  exhibited  either  prepared  in  the  form  of  a  lac. 


(     *6     ) 

or  made  into  pills.  According  to  the  experi- 
ments of  Macbride,*  transparent  solutions  of 
them  may  be  obtained  by  means  of  lime,  and  in 
this  manner  Dr.  Reid  has  recommended  the  so- 
lution of  myrrh. 

The  vapours  or  fumes  of  different  substances 
have  been  often  prescribed  in  order  to  produce 
upon  the  lungs,  effects  similar  to  those  of  fo^ 
mentations  upon  external  parts.  The  fumes  of 
resins  excite  coughing,  and  are  injurious,  while 
the  vapour  of  vitriolic  ether  acts  as  an  antispas-, 
modic,  and  is  beneficial. 

Owing  to  the  general  property  of  carbon  to 
arrest  the  progress  of  putrefaction,  carbonic  acid 
gas  diminishes  the  faetor  of  the  breath  and  of  the 
matter  expectorated;  but  being  among  the  most 
noxious  gases  for  respiration,  it  cannot  be  used 
with  too  much  caution. 

The  elixir  of  vitriol*  is  useful  to  check  the, 
tendency  to  night  sweats,  and  sometimes  con- 
curs, at  a  late  period,  to  restrain  them,  and  to  re- 
store strength. 

The  most  dangerous  symptoms  of  phthisis  are 
often  obviated  or  removed  by  those  remedies. 
We  should  be  aware  of  the  inefficacy  of  bark, 
against  the  use  of  which  the  opinion  of  Lieutaud  J 


*  See  Experimental  Essays,  &c. 

f  The  acidum  sulphuricum  aromaticum  of  the  Edinburgh  Dispen 
gatory  by  Dr.  Duncan. 
%  See  Precis  de  la  Medecine  Pratique,  torn,  u  p.  391. 


(      47      ) 

and  Fothergill*  is  decisive.  The  latter  author 
recommends  it  only  in  that  species  of  consump- 
tion which  arises  from  debility  occasioned  by 
suckling  or  immoderate  uterine  discharges. 

Opiates,  through  the  whole  course  of  the  dis- 
ease, cannot  be  dispensed  with  as  moderating 
cough,  alleviating  pain,  and  procuring  sleep.  In 
the  latter  stages  they  may  also  serve  to  arrest 
diarrhoea;  but  as  the  frequent  use  of  opium  de- 
bilitates the  system,  it  should  be  only  had  re- 
course to  when  absolutely  necessary.  The  sti- 
mulating medicines  mentioned  before  are  found 
more  successful  than  opiates  in  preventing  the 
progress  of  the  disorder. 

Astringents,  as  preparations  of  kino,  catechu, 
or  the  solution  of  sulphate  of  zinc,  in  a  dose  not 
sufficient  to  produce  vomiting,  succeed  some- 
times to  suppress  diarrhoea,  and  thereby  to  re- 
establish the  functions  of  the  intestinal  canal. 

A  nourishing  diet  is  necessary  in  the  advanced 
stage  of  phthisis.  Eggs,  oysters,  the  different 
testacea,  crawfish,  broiled  meat,  jellies,  afford 
the  most  substantial  food:  these  articles  should 
be  given  in  small  quantities,  often  repeated. 
Attention  to  this  circumstance  is  necessary,  that 
fever  may  not  be  excited  or  increased  by  the  dis- 
tention of  the  stomach,  and  the  labour  of  diges- 
tion occasioned  by  a  full  meal.     The  farinacea, 

*  S«e  London  Medical  Observations  and  Inquiries,  vol.  v. 


(     48     ) 

such  as  oats,  maize,  barley,  sago,  arrow-root; 
&c.  are  well  adapted  to  a  weak  state  of  the  sto- 
mach in  this  disease. 

A  milk  diet  has  been  highly  recommended  by 
authors.  While  some  have  given  the  preference 
to  ass's  and  goat's  milk,  others  have  extolled 
the  efficacy  of  human  milk.  The  observations 
of  physicians  in  all  ages  bear  testimony  to  the 
good  effects  of  milk  in  disorders  of  the  lungs; 
but  they  are  not  such  as  to  give  us  reason  to  con- 
sider that  aliment  as  a  specific  remedy.  Milk  is 
not  a  nourishment  suited  to  all  circumstances, 
nor  to  all  constitutions.  The  experience  of  the 
patient  can  alone  determine  the  propriety  of  em- 
ploying it  as  an  article  of  diet,  otherwise  it  may 
impair  the  digestive  functions,  and  become  an 
additional  source  of  disease. 

Wine  of  good  quality,  and  unmixed  with  brandy* 
is  not  to  be  forbidden ;  but  the  use  of  ale  and 
porter  is  infinitely  more  beneficial,  as  they  are 
more  nutritious  and  less  stimulant, 

Change  of  air  and  a  journey,  especially  from  a 
colder  to  a  warmer  situation,  are  not  less  useful 
to  persons  recovering  from  phthisis,  than  they  are 
necessary  to  those  who  receive  no  benefit  from 
the  remedies  which  have  been  noticed. 

Much  service  may  be  derived  likewise  from 
riding  on  horseback.  Both  ancient  and  modern 
authors  have  recommended  exercise  in  this  dis- 
ease.    In  those  cases  which  proceed  from,  or  are 


{     49     ) 

attended  with  haemoptysis,  riding  on  horseback 
should  be  cautiously  made  use  of.  The  cures 
effected  by  exercise,  added  to  the  high  authority 
of  Sydenham  in  favour  of  riding,  afford  abun- 
dant evidence  of  its  utility. 

Authors  have  been  greatly  divided  upon  the 
virtues  and  qualities  of  mineral  waters,  but  they 
all  agree  upon  the  benefit  of  a  journey  to  those 
places  of  general  resort,  and  to  which  probably 
the  patient  is  more  indebted  for  his  recovery  than 
to  any  quality  which  the  water  may  possess. 

Sea  voyages,  since  the  time  of  Pliny*  and  Cel- 
sus,j*  have  been  considered  as  among  the  most 
effectual  remedies  in  pulmonary  consumption,  es- 
pecially voyages  from  a  cold  to  a  temperate  cli- 
mate. 

Sea  air,  sailing,  and  the  exercise  occasioned 
by  the  motion  of  the  ship,  are  together  benefi- 
cial; and  the  sickness  and  vomiting  consequent 
thereon,  especially  to  those  unaccustomed  to  sea 
voyages,  are  often  very  useful. 

The  exercise  of  the  swing  has  been  recom- 
mended to  consumptive  persons  (where  sea 
voyages  were  inconvenient  or  impracticable) 
by  Dr.  Carmichael  Smyth,  of  London,  who  as- 
serts, that  he  prescribed  it  in  a  variety  of  cases 
with  advantage;  but  the  repeated  experiments 
of  Dr.  DuncanJ   on   this  mode  of  exercise  in 

*  See  lib.  xxxi.  cap.  6.  f  See  lib.  iii.  cap.  22. 

%  See  Medical  Commentaries,  vol.  ii.  p.  155. 

7 


\ 


{    so    ) 

phthisis  have  not  been  so  successful,  and  in  his 
opinion  do  not  justify  the  expectations  of  Dr. 
Smyth. 

Riding,  especially  in  an  easy  carriage,  gives 
appetite  and  strength  to  persons  already  debili- 
tated by  the  disease ;  and  it  must  be  remarked 
that  the  good  effects  of  medicines,  diet  and  re- 
gimen, are  more  apparent  when  prescribed  in 
the  early  stage;  and  that  when  predisposition 
exists,  it  is  more  easy,  by  timely  aid  and  atten- 
tion, to  prevent  the  disease,  than  when  advanced 
to  remove  it. 

I  cannot  conclude  this  dissertation  with  lan- 
guage more  applicable  to  the  treatment  of  this 
disease,  than  that  adopted  by  Dr.  Reid : 

Principiis  obsta,  sero  medicina  paratur 
Cum  mala  per  longas  invaluere  moras. 

Ovid. 


THE  END. 


